Children who sustain moderate-to-severe traumatic brain injury (TBI) are at high risk for long-term neurobehavioral sequelae. Little is known, however, about the impact of pediatric TBI on families, or the extent to which recovery from TBI is influenced by the family environment. The purpose of the proposed continuation project is to fill this void through extended follow-up of a sample of children who were hospitalizes between the ages of 6-12 years for either TBI or orthopedic injuries not involving CNS insult. The original study was designed to follow children and families over the first post-injury year. Hypothesis 1 was that TBI in this age group has more adverse and enduring effects on families than orthopedic injuries. Hypothesis 2 was that characteristics of the family environment predict child outcomes, even after injury severity and the child's pre-injury behavioral functioning are taken into account. Preliminary findings support both hypotheses and raise questions with regard to the later, adolescent outcomes of TBI compared to orthopedic injuries. In the proposed project, the majority of current study participants will return for three extended follow-up spaced at one-year intervals. The sample will include 41 children and adolescents with severe TBI, 47 with moderate TBI, and 54 with orthopedic injuries. although previous measures will be readministered and hypotheses are unchanged, additional tests of executive function and social reasoning will be given to the children to investigate later-emerging deficits in these areas. Assessments of family outcomes will also be expanded to include measures of sibling adjustment, daily phone diaries of family activities, and direct observations of parent-child interactions. Analysis will focus on group comparisons, changes over time, and predictors of outcome. Results will clarify injury sequelae, shed light on risk and protective factors, and inform efforts to reduce the long-term morbidity of TBI and other traumatic childhood injures.